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    Citizenship and Identity Documentation

    Medical Care Programs Alert

    New Rules for Citizenship and Identity Documentation

    Basic information will be posted on the MDH website as it becomes available. 

    This information is the most current information available at the time of posting. 

    Individuals who wish to have input and discussion regarding implementation of the new rules are invited to attend several Town Hall Meetings.   

    Questions or suggestions can be emailed to: mdh.healthmd@maryland.gov

    The New Requirement

    The federal Deficit Reduction Act requires that all individuals declaring to be U.S. citizens provide documentation of their citizenship and identity at the time of initial application or annual eligibility review (“re-determination”).  This new requirement applies to all Medical Care Programs including, but not limited to, Medical Assistance, Maryland Children’s Health Program, Primary Adult Care, HealthChoice, Employed Individuals with Disabilities Program, Women’s Breast and Cervical Cancer Program, and all waiver programs. Individuals receiving SSI and Medicare are excluded from this requirement. 

    The Department of Health and Human Services, Centers for Medicare and Medicaid Services, released guidelines to states on June 9, 2006, and published the final interim rules in the Federal Register on July 12, 2006.  That federal directive now indicates that states must begin collecting documentation of citizenship and identity as explained below.  The guidelines can be viewed at:


    The Maryland Department of Health advises individuals who are currently enrolled or who are planning to apply to begin collecting the required documents now.   


    Who is affected? 

    Most new applicants for Medical Care Programs will be required to produce documentation of their citizenship and identity beginning September 1, 2006.   

    Most current recipients will have to show documentation at their annual re-determination, starting with annual reviews that will begin on or after September 1, 2006. 


    Who will not be affected? 

    • SSI and Medicare Recipients do not need to supply additional proof of citizenship and identity, and they will continue to complete the applications and redetermination process as they did before July 1, 2006.

    • Refugees, asylees and other qualified aliens will continue to provide documentation of their status in the same way after July 1, 2006 as they did prior to that date.

    No documents are required for:

    • Newborns whose mother was enrolled in MA or MCHP for the date of birth;

    • Newborns whose mother files an application and is determined eligible for emergency Medicaid (X02) for the delivery;

    • Pregnant women who are determined presumptively eligible;

    • Supplemental Security Income (SSI) recipients;

    • Individuals who are eligible for Medicare; and

    • Refugees, asylees and other qualified aliens.

    The new law does not affect the process by which illegal or non-qualified aliens currently receive emergency-only Medicaid benefits. 


    How will information be made available? 

    MDH will provide training for all Local Health Departments and Local Departments of Social Services prior to September 1, 2006.   

    MDH will hold Town Hall Meetings to get input from all interested parties and discuss how to implement the new requirements. 

    MDH will attempt to secure acceptable documentation for individuals whenever possible.   

    Eligibility caseworkers will tell individuals if and when documents must be provided. 

    MDH will send reminder notices to all current recipients, beginning with those who have an annual re-determination date of September 1 – September 31.  The reminder notice will inform the recipient whether or not proof of their citizenship and identity are required. 

    Which documents are acceptable proofs?

    Documents must only be provided once.  If the required documents are already in the case record, they will not have to be produced.

    One of the following documents may be used to prove both citizenship and identity:

    • U.S. Passport (current or expired);

    • Certificate of Naturalization (N-550 or N-570); or

    • Certificate of Citizenship (N-560 or N-561).

    Individuals born outside the U.S., who were not a U.S. citizen at birth, must present one of those three documents.  Other individuals may use one of the following documents to prove citizenship (a second document to prove identity will also be required). 


    Proof of Citizenship

    • U.S. Birth Certificate;  

    • Record for child under the age of 16 created near the date of birth and showing U.S. place of birth: record on hospital letterhead or other medical record, except immunization record;                  

    • Record showing U.S. place of birth, if created at least 5 years before the individual’s first application.  Record on hospital letterhead, medical record of the birth, institutional admission papers, signed statement by physician or midwife who attended the birth, Vital Statistics notice of birth registration, insurance record;

    • Final adoption decree for child born in U.S.;

    • Certificate of citizen born abroad (DS-1350,     FS-240, FS-545);

    • Military service record showing U.S. place of birth;

    • Evidence of U.S. civil service employment before 6/1/76;

    • Federal or state census record for 1900-1950 showing U.S. citizenship or U.S. place of birth;

    • ID card for naturalized citizen living in Mexico or Canada (I-179 or I-197); or

    • Two written and signed statements by U.S. citizens who have personal knowledge of the individual’s citizenship and why documentation is not available.  At least one of those affidavits must be signed by someone who is not related to the applicant or recipient.  Both signors must prove their own U.S. citizenship and identity. A third affidavit must be signed by the individual, parent, guardian, etc. explaining why the other types of documentation are not available.

    One of the following documents may be used to verify identity: 


    Proof of Identity 

    • Photo driver’s license or MVA ID card;

    • Photo school ID card;

    • Photo federal, state, or local government ID card;

    • U.S. military card or draft record;

    • Military dependent’s ID card; or

    • For children under 16, a school record, nursery or day care record, or written statement signed by parent or guardian (if a written statement was not used as documentation of citizenship).

        Revised 3/22/07